Assessment of Osteonecrosis in the Presence of Instrumentation for Femoral Neck Fracture Using Contrast-Enhanced MAVRIC Sequence

Abstract

Background

Evaluating postoperative femoral neck facture (FNF) with metal fixation hardware is commonly performed using radiographs. MRI has greater sensitivity and specificity to evaluate osteonecrosis (ON) but is often challenging due to the image distortion caused by metallic hardware.

Questions/Purposes

The aim of this study is to compare fast spin-echo (FSE) and multi-acquisition variable-resonance image combination (MAVRIC) sequences in assessing ON following metallic fixation of FNF and determining feasibility of semi-quantitative perfusion using MAVRIC.

Methods

Radiography and MRI were performed at 3 and 12 months postoperatively, using FSE and pre- and post-gadolinium contrast MAVRIC sequences in 21 FNF patients. The presence and volume of ON were recorded. Signal intensity (SI) enhancement was measured on the MAVRIC sequences within the center and rim of ON; with the ilium and femoral diaphysis as controls. The detection rate of ON between MAVRIC and FSE images was evaluated as the difference of percent enhancement across the defined regions of interest.

Results

ON was detected in 0% of radiographs, in 67% of FSE, and in 76% of MAVRIC images at 3 months follow-up, with similar results at 12 months. MAVRIC images had larger ON volume than FSE images at both time points. A significant percentage SI enhancement was only detected in the ON rim.

Conclusion

Radiographs could not detect ON following metallic fixation of FNF. MAVRIC is more sensitive than FSE for determining the volume of ON. SI measurements using MAVRIC may provide an indirect assessment of perfusion.

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Acknowledgments

The authors would like to thank Joo Jung RT (MR) for his assistance in performing this study. This project has been supported by a grant from the AO Research Fund of the AO Foundation (AO Research Grant F-09-6H).

Disclosures

Conflict of Interest

Jonathan P. Dyke, PhD, Lionel E. Lazaro, MD, Parina Shah, MS and Dean G. Lorich, MD have declared that they have no conflict of interest. Nadja A. Farshad-Amacker, MD reports grants from AO Research Fund during the study. Matthew F. Koff, PhD reports other from GE Healthcare during the study. Hollis G. Potter, MD reports other from GE Healthcare during the study.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Correspondence to Matthew F. Koff PhD.

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Level of Evidence: II: Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard)

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Farshad-Amacker, N.A., Koff, M.F., Dyke, J.P. et al. Assessment of Osteonecrosis in the Presence of Instrumentation for Femoral Neck Fracture Using Contrast-Enhanced MAVRIC Sequence. HSS Jrnl 12, 51–58 (2016). https://doi.org/10.1007/s11420-015-9475-3

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Keywords

  • osteonecrosis
  • avascular necrosis
  • femoral neck fracture
  • metal artifact